Minimally Invasive Surgical Appartus and Methods

Abstract

Apparutus and methods are described for performing percutancous catheter-based interventional surgery. The apparatus comprises first and second devices that are located in adjacent body cavities, such as adjacent blood vessels, the first device being capable of transmitting a directional signal that can be received by the second device. The direction of the signal is correlated with the facility to direct therapy, such that improved accuracy in therapy placement is thereby achieved. Methods for treating patients utilising the means and apparatus are also provided.

1 - 48 . (canceled) 
   
   
       49 . Apparatus for directing therapy within the body of a patient, the apparatus comprising:
 a) a first therapeutic device that is locatable within the lumen of a first body cavity, the first therapeutic device comprising elongate body upon which is located a signal transmitter for generating a directional signal;   b) a second therapeutic device that is locatable within the lumen of a second body cavity adjacent to the first body cavity, the second therapeutic device comprising an elongate body upon which is located a receiver for receiving the directional signal; and   c) a therapeutic member for administering therapy to the body of the patient   
     wherein, therapy is directed by aligning the first therapeutic device with the second therapeutic device via the directional signal transmitted from the signal transmitter located on first therapeutic device, which is received by the receiver located on the second therapeutic device, and administering therapy at a location that is aligned to the path taken by the directional signal. 
   
   
       50 . The apparatus of  claim 49 , wherein the therapeutic member is comprised within the elongate body of the first therapeutic device. 
   
   
       51 . The apparatus of  claim 49 , wherein the therapeutic member is comprised within the elongate body of the first therapeutic device and can be retractably deployed therefrom. 
   
   
       52 . The apparatus of  claim 49 , wherein the therapeutic member is comprised within the elongate body of the second therapeutic device. 
   
   
       53 . The apparatus of  claim 49 , wherein the therapeutic member is comprised within the elongate body of the second therapeutic device and can be retractably deployed therefrom. 
   
   
       54 . The apparatus of  claim 49 , wherein the directional signal is selected from the group consisting of: ultrasound; laser radiation; a radio signal; microwave radiation; and other electromagnetic radiation. 
   
   
       55 . The apparatus of  claim 49 , wherein the signal transmitter comprises a signal transducer. 
   
   
       56 . The apparatus of  claim 49 , wherein the signal transmitter comprises an ultrasound signal transducer. 
   
   
       57 . The apparatus of  claim 49 , wherein the signal transmitter comprises an array of transducer elements. 
   
   
       58 . The apparatus of  claim 49 , wherein the receiver comprises a receiving transducer. 
   
   
       59 . The apparatus of  claim 49 , wherein the receiver comprises an ultrasound receiving transducer. 
   
   
       60 . The apparatus of  claim 49 , wherein the receiver comprises a receiving transducer that is an omnidirectional receiver. 
   
   
       61 . The apparatus of  claim 49 , wherein the directional signal is directed at an angle perpendicular to a longitudinal axis of the elongate body of first therapeutic device. 
   
   
       62 . The apparatus of  claim 49 , wherein the directional signal is directed at an oblique angle relative a longitudinal axis of the elongate body of the first therapeutic device. 
   
   
       63 . The apparatus of  claim 49 , wherein the directional signal is directed at an oblique angle relative a longitudinal axis of the elongate body of the first therapeutic device and wherein the oblique angle is preferably between around 20° and around 60° to the perpendicular, more preferably between around 30° and around 50° to the perpendicular, and most preferably around 45° to the perpendicular, when 0° corresponds to the longitudinal axis of the elongate body of the first therapeutic device. 
   
   
       64 . The apparatus of  claim 49 , wherein the first and second therapeutic devices are catheters. 
   
   
       65 . The apparatus of  claim 49 , wherein the therapeutic member comprises a device selected from the group consisting of: a cannula; a laser; a radiation-emitting device; a probe; a drill; a blade; a wire; a needle; and combinations thereof. 
   
   
       66 . The apparatus of  claim 49 , wherein the therapeutic member further comprises one or more sensors. 
   
   
       67 . The apparatus of  claim 49 , wherein the therapeutic member further comprises a pressure sensor. 
   
   
       68 . The apparatus of  claim 49 , wherein the therapeutic member further comprises a signal transmitter. 
   
   
       69 . The apparatus of  claim 49 , wherein the therapeutic member further comprises a ultrasound transmitter. 
   
   
       70 . The apparatus of  claim 49 , wherein the first and second body cavities are blood vessels. 
   
   
       71 . The apparatus of  claim 49 , wherein the first body cavity is an artery and the second body cavity is a vein. 
   
   
       72 . The apparatus of  claim 49 , wherein the first body cavity is a vein and the second body cavity is an artery. 
   
   
       73 . The apparatus of  claim 49 , wherein the elongate body of the first therapeutic device further comprises at least one centering member, for centering the first therapeutic device within the lumen of the first body cavity, wherein the at least one centering member comprises a device selected from the group consisting of: a bladder; a balloon; a looped structure; a wire; a probe; a leg; a coil; a helix; and an expandable stent. 
   
   
       74 . The apparatus of  claim 49 , wherein the elongate body of the second therapeutic device further comprises at least one centering member, for centering the second therapeutic device within the lumen of the second body cavity wherein the at least one centering member comprises a device selected from the group consisting of: a bladder; a balloon; a looped structure; a wire; a probe; a leg; a coil; a helix; and an expandable stent. 
   
   
       75 . The apparatus of  claim 49 , wherein the first therapeutic device further comprises at least one centering member in the form of an annular balloon which encircles the elongate body of the first therapeutic device and that can be expanded radially outwardly therfrom, thereby centering the first therapeutic device within the lumen of the first body cavity. 
   
   
       76 . The apparatus of  claim 49 , wherein the second therapeutic device further comprises at least one centering member in the form of an annular balloon which encircles the elongate body of the second therapeutic device and that can be expanded radially outwardly therfrom, thereby centering the second therapeutic device within the lumen of the second body cavity. 
   
   
       77 . The apparatus of  claim 49 , wherein the first therapeutic device further comprises at least one centering member in the form of a plurality of flexible members arranged in parallel at intervals around the periphery of the elongate body of the first therapeutic device, wherein compression of the plurality of flexible members can be effected by way of a ring slidably located on the elongate body at a position adjacent to the ends of the plurality of flexible members, the sliding member being capable of translational movement along the longitudinal axis of the elongate body, and wherein the ring allows a compressive force to be applied to the plurality of flexible members thereby causing the flexible members bow outwardly relative to the elongate body of the first therapeutic device. 
   
   
       78 . The apparatus of  claim 49 , wherein the second therapeutic device further comprises at least one centering member in the form of a plurality of flexible members arranged in parallel at intervals around the periphery of the elongate body of the second therapeutic device, wherein compression of the plurality of flexible members can be effected by way of a ring slidably located on the elongate body at a position adjacent to the ends of the plurality of flexible members, the sliding member being capable of translational movement along the longitudinal axis of the elongate body, and wherein the ring allows a compressive force to be applied to the plurality of flexible members thereby causing the flexible members bow outwardly relative to the elongate body of the second therapeutic device. 
   
   
       79 . A method for aligning a first therapeutic device, having an elongate body, located within the lumen of a first body cavity with a second therapeutic device, having an elongate body, located within the lumen of a second body cavity that is adjacent to the first body cavity, the method comprising:
 a) locating a signal transmitter on the elongate body of the first therapeutic device, wherein the signal transmitter is capable of generating a directional signal; and   b) locating a receiver on the elongate body of the second therapeutic device, wherein the receiver is for receiving the directional signal;   
     wherein, alignment of the first therapeutic device and the second therapeutic device in their respective first and second body cavities is achieved when the directional signal transmitted from the transmitter on the first therapeutic device is received by the receiver on the second therapeutic device. 
   
   
       80 . The method of  claim 79 , wherein the directional signal is selected from the group consisting of: ultrasound; laser radiation; a radio signal; microwave radiation; and other electromagnetic radiation. 
   
   
       81 . The method of  claim 79 , wherein the signal transmitter comprises a signal transducer. 
   
   
       82 . The method of  claim 79 , wherein the signal transmitter comprises an ultrasound transducer. 
   
   
       83 . The method of  claim 79 , wherein the signal transmitter comprises an array of signal transducer elements. 
   
   
       84 . The method of  claim 79 , wherein the receiver comprises a receiving transducer. 
   
   
       85 . The method of  claim 79 , wherein the receiver comprises an ultrasound receiving transducer. 
   
   
       86 . The method of  claim 79 , wherein the receiver comprises an omnidirectional receiving transducer. 
   
   
       87 . The method of  claim 79 , wherein the directional signal is directed at an angle perpendicular to a longitudinal axis of the elongate body of the first therapeutic device. 
   
   
       88 . The method of  claim 79 , wherein the directional signal is directed at an oblique angle relative a longitudinal axis of the elongate body of the first therapeutic device, and wherein the oblique angle is preferably between around 20° and around 60° to the perpendicular, more preferably between around 30° and around 50° to the perpendicular, and most preferably around 45° to the perpendicular, when 0° corresponds to the longitudinal axis of the elongate body of the first therapeutic device. 
   
   
       89 . The method of  claim 79 , wherein the first and second therapeutic devices are catheters. 
   
   
       90 . Apparatus for traversing tissue intervening first and second anatomical cavities within the body of an animal, comprising:
 a) a launching device suitable for location within the first anatomical cavity, the launching device comprising
 (i) an elongate outer sheath with a distal end and a proximal end, the outer sheath defining and enclosing an interior lumen; 
 (ii) a signal transducer located at the distal end of the outer sheath, the signal transducer being arranged so as to transmit a directional signal; and 
 (iii) traversing member for traversing the tissue intervening the first and second body cavities, the traversing member being located within the lumen at the distal end of the outer sheath, wherein in use the traversing member is in a retracted state and can be extended out of the lumen via an aperture in the outer sheath such that it engages and traverses the tissue intervening the first and second anatomical cavities, and wherein extension of the traversing means is along a path that is aligned with the direction of the signal; and, 
   b) a target device suitable for location within the second anatomical cavity, the target device comprising
 (i) an elongate outer sheath with a distal end and a proximal end, the outer sheath defining and enclosing an interior lumen; and 
 (ii) a signal receiving transducer located at the distal end of the outer sheath; 
 (iii) wherein, in use, the signal transducer on the launching device transmits the directional signal that is capable of being received by the signal receiving transducer on the target device, and 
   
     when the signal is received by the signal receiving transducer on target device it is determined that the devices are located in the correct juxtaposition within their respective anatomical cavities such that the traversing member can be extended out of the launching device and traverses the tissue intervening the first and second anatomical cavities. 
   
   
       91 . The apparatus of  claim 90 , wherein the directional signal is selected from the group consisting of ultrasound, laser radiation, a radio signal, microwave radiation and other electromagnetic radiation. 
   
   
       92 . The apparatus of  claim 90 , wherein the directional signal is directed at an angle perpendicular to a longitudinal axis of the launching device. 
   
   
       93 . The apparatus of  claim 90 , wherein the directional signal is directed at an oblique angle relative a longitudinal axis of the launching device and wherein the oblique angle is preferably between around 20° and around 60° to the perpendicular, more preferably between around 30° and around 50° to the perpendicular, and most preferably around 45° to the perpendicular, when 0° corresponds to the longitudinal axis of the launching device. 
   
   
       94 . The apparatus of  claim 90 , wherein the traversing member comprises a device selected from the group consisting of a cannula; a laser; a radiation-emitting device; a probe; a drill; a blade; a wire; a needle and combinations thereof. 
   
   
       95 . The apparatus of  claim 90 , wherein the traversing member traverses the tissue intervening the first and second anatomical cavities along a path that is aligned to the path taken by the directional signal. 
   
   
       96 . The apparatus of  claim 90 , wherein the animal is a human. 
   
   
       97 . A method for directing therapy in the body of a patient, comprising:
 a) placing a first therapeutic device into a first body cavity, the first therapeutic device comprising signal means for generating a directional signal, and therapeutic means for administering therapy to the body of the patient; and   b) placing a second therapeutic device into a second body cavity that is adjacent to the first body cavity, the second therapeutic device comprising receiving means for receiving the directional signal;   
     wherein, therapy is directed by aligning the first therapeutic device with the second therapeutic device via the directional signal transmitted by the first therapeutic device being received by the second therapeutic device, and administering therapy at a location that intersects the path taken by the directional signal. 
   
   
       98 . The method of  claim 97 , wherein the step of administering therapy comprises creation of an aperture in tissue between the first and second body cavities, thereby allowing fluid communication between the first and second body cavities.